Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use,
ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

Email Address:

We never sell or give out your contact information.
We respect our readers' privacy.

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Though it’s not without competitors, I’d argue that Apple’s HealthKit has stood out since its inception, in part because it was relatively early to the game (mining patient-centered data) and partly because Apple products have a sexy reputation. That being said, it hasn’t exactly transformed the health IT industry either.

Now, though, with the acquisition of Gliimpse, a startup which pulls data from disparate EMRs into a central database, it’s become clearer what Apple’s big-picture goals are for the healthcare market – and if its business model works out they could indeed change health data industry.

According to a nifty analysis by Bloomberg’s Alex Webb, which quotes an Apple Health engineer, the technology giant hopes to see the health data business evolve along the lines of Apple’s music business, in which Apple started with a data management tool (the iPod) then built a big-bucks music platform on the device. And that sounds like an approach that could steal a move from many a competitor indeed.

Apple’s HealthKit splash
Apple made a big splash with the summer 2014 launch of HealthKit, a healthcare data integration platform whose features include connecting patient generated health data with traditional systems like the Epic EMR. It also attracted prominent partners like Cedars-Sinai Medical Center and Ochsner Health System within a year or so of its kickoff.

Still, the tech giant has been relatively quiet about its big-picture vision for healthcare, leaving observers like yours truly wondering what was up. After all, many of Apple’s health data moves have been incremental. For example, a few months ago I noted that Apple had begun allowing users to store their EMR data directly in its Health app, using the HL7 CCD standard. While interesting, this isn’t exactly an earth-shattering advance.

But in his analysis — which makes a great deal of sense to me – Bloomberg’s Webb argues that Apple’s next act is to take the data it’s been exchanging with wearables and put it to better use. Apple’s long-awaited big idea is to turn Apple’s HealthKit into a system that can improve diagnoses, sources told Bloomberg.

Also, Apple intends to integrate health records as closely with its proprietary devices as possible, offering not only data collection but suggestions for better health in a manner that can’t be easily duplicated on Android platforms. As Webb rightly points out, such a move could undermine Google’s larger healthcare plans, by locking consumers into Apple technology and discouraging a switch to the Google Fit health tracking software.

Big vision, big questions
As we know, even a company with the reputation, cash and proprietary user base enjoyed by Apple is far from a shoo-in for consumer health data dominance. (Consider the fate of Microsoft HealthVault and Google Health.) Its previous successes have come, as noted, by creating a channel then dominating that channel, but there’s no guarantee it can pull off such a trick this time.

For one thing, the wearables market is highly fragmented, and Apple is far from being the leader. (According to one set of stats, Fitbit had 25.4% of the global wearables market as of Q2 ’16, Xiaomi 14%, and Apple just 7%.) That doesn’t bode well for starting a health tracker-based revolution.

On the other hand, though, Apple did manage to create and dominate a channel in the music business, which is also quite resistant to change and dominated by extremely entrenched powers that be. If any upstart healthcare player could make this happen, it’s probably Apple. It will be interesting to see whether Apple can work its magic once again.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

That’s the news as reported by Reuters in late October. The article talks about Salesforce’s interest in creating a healthcare business and believe it can reach $1 billion in revenue. The article also highlights how SalesForce has recently hired over a dozen people from the healthcare and medical device sectors.

Plus, they even talk about the roll out of the CareWeb Messenger product that is built on the top of Salesforce’s technology:

The University of California at San Francisco, for instance, rolled out CareWeb Messenger, built on top of Salesforce’s technology, through which doctors, nurses and patients talk online and on mobile devices. UCSF and Salesforce have close ties: in April, CEO Marc Benioff donated $100 million to its children’s hospital.

I’ll be interested to see how this first product plays out. It actually fits into Salesforce’s core competencies quite well. Although, the secure healthcare messaging space is a crowded one. With that said, I was invited to a Salesforce event to talk about healthcare. Unfortunately, the timing was bad so I couldn’t make it, but now I’m particularly interested in what was said at the event.

It seems that sooner or later, all of the big tech companies come after healthcare. We’ve seen the same with Google, Microsoft, Dell, Apple, Samsung, and many more. While it must be incredibly enticing for these companies to come after a trillion dollar market like healthcare, most of these companies come into healthcare with an amazing amount of naivety as to the complexities of healthcare. Once they get in, they find these complexities and change their mind. We’ll see if Salesforce does something similar.

With that said, Salesforce has the money, the platform and the connections to do something in healthcare. Plus, I welcome fresh ideas and perspectives from companies like Salesforce in healthcare. I think that we all agree that there’s a huge opportunity for technology to improve healthcare. I want as many people working on finding those solutions as possible. Doesn’t hurt to have a multi-billion dollar company taking an interest in it as well.

What do you think of Salesforce’s entrance into healthcare? Will they be a major player? Where do you think it makes sense for them to focus their efforts?

Some of the articles on this talk about Salesforce building an EHR or things like that. Given the regulations and the environment, I never see that happening. Although, with the money they have available to them, maybe they’ll surprise us all.

Kyle is CoFounder and CEO of Pristine, a VC backed company based in Austin, TX that builds software for Google Glass for healthcare, life sciences, and industrial environments. Pristine has over 30 healthcare customers. Kyle blogs regularly about business, entrepreneurship, technology, and healthcare at kylesamani.com.

OMSignal recently raised $10M to build sensors into smart clothes. Sensoria recently raised $5M in pursuit of the same mission, albeit using different tactics. Meanwhile, Apple hired the former CEO of Burberry, Angela Ahrendts, to lead its retail efforts.

And Google is pushing Android Wear in a major way, with significant adoption and uptake by OEMs.

There’re two distinct approaches that are evolving in the smart clothing space. OMSignal, Sensoria, and Apple are taking a full-stack, vertical approach. OMSignal and Sensoria are building sensors into clothing and selling their own clothes directly to consumers. Although Apple hasn’t announced anything to compete with OMSignal or Sensoria, it’s clear they’re heading into the smart clothing space in traditional Apple fashion with the launch of Health, the impending launch of the iWatch, and the hiring of Angela Ahrendts.

Google, on the other hand, is licensing Android Wear to OEM vendors in traditional Google fashion: by providing the operating system and relevant Google Services to OEMs who can customize and configure and compete on retail and marketing. Although Google is yet to announce partnerships with any more traditional clothing vendors, it’s inevitable that they’ll license Android Wear to more traditional fashion brands that want to produce smart, sensor-laden clothing.

Apple’s vertically-integrated model is powerful because it allows Apple to pioneer new markets that require novel implementations utilizing intertwined software and hardware. Pioneering a new factor is especially difficult when dealing with separate hardware and software vendors and all of the associated challenges: disparate P&Ls, different visions, and unaligned managerial mandates. However, once the new form factor is understood, modular hardware and software companies can quickly optimize each component to drive down costs and create new choices for consumers. This approached has been successfully played out in the PC, smartphone, and tablet form factors.

Apple’s model is not well-suited to being the market leader in terms of raw volume. Indeed, Apple optimizes towards the high end, not the masses and this strategy has served them well. But it will be interesting to see how they, along with other vertically integrated smart-clothing vendors, approach the clothing market. Fashion is already an established industry that is predicated on variety, choice, and personalization; these traits are the antithesis of the Apple model. There’s no way that 20% or even 10% of the population will wear t- shirts, polos, tank tops, dresses, business clothes, etc., (which I’ll collectively call the “t-shirt market”) made by a single company. No one company can so single-handedly dominate the t-shirt market. People simply desire too many choices for that to happen.

OMSignal and Sensoria don’t need to worry about this problem as much as Apple since they’re targeting niche use cases in fitness and health. However, as they scale and set their sites on the mass consumer market, they will need to figure out a strategy to drive massive personalization. Apple, given its scale and brand, will need to address the personalization problem in the t- shirt market before they enter it.

The t-shirt market is going to be exciting to watch over the coming decades. There are enormous opportunities to be had. Let the best companies win!

Feel free to a drop a comment with how you think the market will play out. Will the startups open up their sensors to 3rd party clothing companies? Will Apple? How will Google counteract?

Kyle is CoFounder and CEO of Pristine, a VC backed company based in Austin, TX that builds software for Google Glass for healthcare, life sciences, and industrial environments. Pristine has over 30 healthcare customers. Kyle blogs regularly about business, entrepreneurship, technology, and healthcare at kylesamani.com.

Apple recently announced Health and Healthkit as part of iOS 8, and initial responses have been mixed.

For the uninitiated, Apple Health is a central dashboard for health related information, packaged for consumers as an iOS app. Consumers open the app and see a broad array of clinical indicators (e.g. as physical activity, blood pressure, blood glucose, sleep data). You can learn more about Health and Healthkit from Apple.

The rest of this post assumes significant understanding of modern health IT challenges such as data silos, EMPIs, HIEs, and an understanding of what Health and Healthkit can and can’t do. I’ll address what Apple Health does well, ask some questions, and then provide some commentary.

Apple Health does a few things well:

1) Apple Health acts as a central dashboard for consumers. Rather than switching between five different apps, Health provides a central view of all clinical indicators. In time, Health could help patients understand the nuances of their own data. By removing friction to seeing a variety of indicators in a single view, patients may discover correlations that they wouldn’t have observed before. With that information, consumers should be able to adjust behaviors to lead healthier lifestyles.

2) Apple Health provides a robust mechanism for health apps to share data with one another. Until now, health app developers needed to form partnerships with one another and develop custom code to share information; now they can do this in a standardized way with minimal technical or administrative overhead. This reduces app lock-in by enabling data liquidity, empowering consumers to switch to the best health app or device and carry data between apps. This is a big win for consumers.

Unanswered questions:

1) How does Apple Health actually work? Apple provided virtually no details. Does the patient need the Epic MyChart app on their phone? Is there custom code integrating iOS to Epic MyChart? Is there a Mayo Clinic app that is separate from Epic MyChart? If not, how does Apple Health know that the consumer is a Mayo patient? Or a Kaiser Permanente patient? Or a Sutter Health patient?

2) Does the patient give consent per data value, or is it all or nothing? How long does consent last? Must consent be taken at the hospital, or can the patient opt in or out any time on their phone? Who within the health system can access the consented data?

3) Given that there are hundreds of EpicCare silos and dozens of CareEverywhere silos, how does Apple Health decide which silo(s) to interface with? Does data go to an HIE or to an EMR? If to an HIE, can all eligible connected providers access the data with consent? If a patient has records in multiple HIEs and EMRs (which they likely do), how does Apple Health determine which HIE(s) to push and pull data from?

4) Does Apple Health support non-numerical data such as CCDAs? What about unstandardized data? For example, PatientIO allows providers to develop customized care plans for patients that can include almost any behavioral prescription. Examples include water intake, exercising at a certain time of the day, taper schedules, etc.

5) Can providers write back to a patient’s Health profile? Given that open.epic doesn’t allow Epic to send data out, how could Apple Health receive data from Epic?

7) How will Apple handle competing health apps installed on the same consumer’s phone? For example, if I tap “more diabetes info” in Apple Health, will it open Mayo Clinic’s app (and if so, to the right place in the Mayo Clinic app?) or the blood glucose tracking app that came with with my blood glucose meter? Or my iTriage or WebMD app?

8) Is Apple Health intended to function as a patient-centric HIE? If so, what standards does it support? CCDA? FHIR? Direct?

Comments:

1) The Apple-Epic partnership is obviously built on open.epic, which Epic announced in September of 2013. It’s likely that Apple and Epic reached an agreement around that time, and asked the public for ideas on how to shape the program to get a sense of what developers wanted.

2) The only way to succeed in health IT is to force the industry to conform to one’s standards, or to support a hybrid of hybrids approach. Early indicators show Apple (predictably) trending toward the former. Unfortunately, Apple’s perennially Apple-centric approach inhibits supporting the level of interoperability necessary to power an effective consumer health strategy. Although Apple provides a great foundation for some basic functions, the long term potential based on the current offering is limited. What Apple has produced to date provides for sexy screenshots, but appears to fall short of addressing the core interoperability and connectivity issues that plague chronic disease management and coordination of care.

3) In a hypothetical world at some indeterminate point in the future, there would be a patient-facing, DNS-like lookup system for provider organizations (Direct eventually?). Patients should be able to lookup provider organizations and share their data with providers selectively. Apple Health provides a great first step towards that dream world by empowering patients to see and, to some extent, control their own data.

Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use,
ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!

Email Address:

We never sell or give out your contact information. We respect our readers' privacy.